Defining various categories of tuberculosis in children:
A. Asymptomatic Mantoux Positivity: Implies that the patient has no tuberculous lesion and is only a tuberculin positivity.
B. Symptomatic Mantoux positive - Presence of fever, cough, loss of weight, chest infection not responsive to antibiotics with Mantoux positivity.
C. Pulmonary Primary Complex (PPC) - is suspected when the following criteria are met with
i) Essential criteria:
- Symptoms of fever, cough, loss of weight, chest infection not responding to antibiotics.
- X-ray lesion suggesting tuberculosis such as hilar adenopathy or parenchymal opacity.
ii) Supportive criteria:
- Positive Mantoux test
- Superficial lymphadenitis proven to be tuberculous etiology
- Positive Family history of tuberculosis
- Grade III or IV malnutrition
- Non vaccination with BCG
D. Progressive Pulmonary Disease (PPD)- Progression of the PPC lesion is defined as progressive pulmonary disease (PPD) nodal lesions progressing to
- Bronchial obstruction
- Endobronchial tuberculosis
- Spread to adjacent areas.
Paranchymal lesion may progress to
- Lobar consolidation
- Pleural effusion.
E. Disseminated/Miliary tuberculosis -
The term is used when more than one organ or non cotiquous body tissues are involved with tuberculosis. Miliary tuberculosis is a specific form of disseminated tuberculosis with classical radiological findings.
- Acute with respiratory distress, weight loss fever etc
- Cryptic type with no pulmonary findings,
- presenting with hepatosplenomegaly, lymphadenopathy, meningitis, pleural, pericardial and other organ involvement.
- Fundoscopy often reveals choroid tubercles.
- Tuberculin often negative
- Direct smear for AFB may be positive
- Biopsy of the Bone marrow, liver, lymphnode, may reveal typical granulomas from which the AFB should be demonstrated.
F. Neurotuberculosis may be of several types -
Serous TB meningitis
G. Others -